Provider Demographics
NPI:1164959243
Name:LIGHTCAP, JOHANNA ELIZABETH (DPM)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ELIZABETH
Last Name:LIGHTCAP
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1449
Mailing Address - Country:US
Mailing Address - Phone:302-644-0100
Mailing Address - Fax:302-644-0238
Practice Address - Street 1:334 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1449
Practice Address - Country:US
Practice Address - Phone:302-644-0100
Practice Address - Fax:302-644-0238
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0010265213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery